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Home My WebLink About0026 WAYSIDE LANE - Health 26 Wayside Lane W. Barnstable A = 110 019 TOWN OF BARNSTABLE v LOCATION q/, IWAY6-1` \-Ayv lF- SEWAGE # -a"i VILLAGE AIZN l C00 -e ASSESSOR'S MAP & LOT 9 INSTALLER'S NAME & PHONE NO. e-- fS SEPTIC TANK CAPACITY i S Q !,5 LEACHING FACILITY-Atype) (size) Q- 40? NO. OF BEDROOMS PRIVATE WELL OAP BLIC WARE BUILDER OR OWNER L CC, DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ' VARIANCE GRANTED: Yes No / ` v G'DOno o Sc y wow, PG1f�G� ,� -• N ................_....... ``�' Fxs. ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4�I . ...................... .. �Q 4 rlirtt ion for Disposal Works. Tonstrurtion rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............... t�..t--(�,:.(.. .y`�-C.,... .sA..r -- ....................C,4.. ....2. k :C ....._..-----•-•---- Location-Address or Lot No. ..................Nam'-� ..--- -hn 1�` CL.--...f _ 1 ._.. .... -- -----••-•----..... W Own Address -•- - Installer Address Type of Building L4 Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building p,, yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtures --•-••---•-•---•-----------•--••.........................._ W Design Flow............. �____.....__........_gallons per person per day. Total ily flow____.�-:{._�.0....................gallons. WSeptic Tank—Liquid capacity_l_ gallons Length....I_Ca .__. Width.... Diameter________________ Depth................ x Disposal Trench—No.____?�......___. Width....... ............Total Length....��, ...... Total leaching area. _ ...sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet......:............. Total leaching area..................sq. ft. Z __Ct1wr Distribution box (—}— Dosing tank ( ) a Percolation Test Results Performed by........................................................................... Date..__......___----------------------- .._. ,� Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_________________:__ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to'ground water........................ a ...-------------------------------••---...-...........................................................-••--••••••••••-•••-••--•....._._...--•---•..._.---•••••. 0 Description of Soil........................................................................................................................................................................ .........................................................-....................... .......................................--------- •--••....:•-••-•••-••••-••--•-----•-----•- U Nature of Repairs or Alterations—Answer when applicablet__�V-STj'o....... ...................:...... .........1- ?L�U... .......... �------�-.................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board lth. Signed_.. - Date Application Approved By...............................__________flfl 3taNING.4_:NGINEEE3,J!(Il_)ST SUPERVISE Application Disapproved for the following reasons!NSTALLATION AND CEFMFYDN�RITINI--------- Date---•• -M THE SYSTEIIII W�kS" Date Permit No.................•------------------------------•-•-_._. Issued............................................ ..........— Date THE COMMONWEALTH OF MASSACHUSETTS Q BOARD OF HEALTH ' . .! ! ..........OF......�.�.�.. ........................... (Irdif iratr of Tomplittnr THIS IS TO CERTIFY, That the Individual Sewage DisposaIL-9ister.9 constructed ( ) or Repaired-( by-•-•--•••••••••••••-•-...6� -.......�. ..... O_Q.r.: ......... At >`,.1t.................•=• •- Installer at.........................0--4-4.......... 1P�__ —----------------- Wyz!r : tom,�� ----------------- ------------------ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... S N< SV O Ll 1/ 0....................... Fzz 'q THE COMMONWEALTH -qF MASSACHUSETTS BOARD OF HEALTH .......OF... ........................ Appliration for Disposal Works Tonstrurtion rtrt td , Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal 'System at: .. ................... Location--Address or Lot No. K..................... ......... bA\ .......................... ------------------—---- 11. Address Owner �:) ................ ........ .......... ........... i4i&--s-s-------------------------------------------- Type of Building Installer V Size Lot............................Sq. feet Dwelling—No. of Bedrooms.........q.............................Expansion Attic Garbage Grinder 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fixtures ..................................................................................................................................................... Design Flow............::':St'.75 ................gallons per person per day. Total daily flow......H.A.0. ....................gallons.Septic Tank—Liquid capacity.I.SMgallons Length....!a Width....4.1....... Diameter________________ Depth_...__.._....... Disposal Trench—No......:��.......... Width_._.�U........... Total Length.__ ...... Total leaching area_y.5 ...sq. ft. Seepage Pit No_____________________ Diameter.___.__.____.___._.. Depth below inlet____..___.._...____. Total leaching area..................sq. f t. Z _,_Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date___________________...._..__....._.._... Test Pit No. I................minutesperinch Depth of Test Pit____...___..._______ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit__._..._....________ Depth to ground water.__________._________... ........................................... ............................................................................................................. 0 Description of Soil........... ....................................................................................................................................................... --------------------------------------------------"--------------------------- -------------------*--------*------------------------------------------------ -------------------*------ U Nature of Repairs or Alterations—Answer when applicable.... ......10:�K. ........................... I -</r,7,> —sevk k t�" 4,&/,n "/- - .............. ............V,. 1...................... -74..................................... -i ............ ..... ..........0,:enen...Ak-fri..... Agreement: r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board.gf-hpIth. Signed............ .. ............................... "G.................... ?Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:........................................................................................................... .........................................................................................................................................................................................:............... Date PermitNo......................................................... Issued-.................. .............................. Date ——————————————-——————————————————————————————— ` —_ __ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /Y2 hil)c- --T ............... ............. ............................... .............................. (Infifirate of Toutplitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by.... 4A-/V-) . < � - 2. - I try .........I........................................................... . ........... .... ................................................................... Installer at........................ra.Ln.......... . ................... ..................................................................... has been installed in accordance with the provisions, of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._______________________________________ dated_....___._..._._....._._.._.___._____..._____._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... ------------------------------------------------------------------V '� MMONWEALTH OF MASSACHUSETTS A I,/I T1 THE COMMONWEALTH OF HEALTH DESIGNING ENGINEER MUST SUPERVISE INSTALLATION AND CERTIFY IN WRITING L It ' 0, K OF-,,, THE-SYSTEW WAS ANSTALLEDIN-STRICT No ....... ...... ACCORDANCE TO P[Ahe .............. - Disposal Works Tonstruction "plermit Permission is hereby granted.............. ......L,.A.kuf.!Q.........<-4�2.7t,Z........ ................I........................................ to Construct or Repair (/,)-arr Individual Sewage Disposal System at No...__... 14—/4:� pA.�, ............................................. ..........w........7....................... ........Tw......... ------- . ....... Street as shown on the application for Disposal Works Construction Permit No................... Dited......................................... A=-- ..................... - ------ ....... Board of Health DATE.................;,!.......................................................... LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME & ADDRESS (17 B U I L D E.R OR OWNER --✓ L'O.�ITo 2,o GTo•9!S DATE PERMIIT ISSUED "0-Z," DA.T E COMPLIANCE ISSUED �( V s� No.-`-=`=- Fee--- ---- BOARD OF HEALTH TOWN OF BARNSTABLE ZippYicat ion-*rVerr Cootructionpermit Applic t'on is hereby made for a perm to Construct (. ), Alter ( ), or Repair ( <an individual Well at: - - -- -- - `�'-�- - ---------------------------------------------------— -- --------------- ocation — AdclMs Assessors Map and Parcel --vim/ — — —-- -- -- --------------------------—---------------------- - - ----------- Ow r Address ------------------------------------ Installe — Driller Address T of Building Dwelling,- t=' ---=--.------------------- Other - Type of Building--------------- No. of Persons----�--------- Type of Well Purpose of Well-- --- -- c------- Agreement: The undersigned agrees to,install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation unt' a Certificate of Compliance has been issued by the Board of Health. qD Signed - - -- — ' date Application Approved By ---- --- ------------------------ —___-- _ date Application Disapproved for,the following reasons:------------------------------___-__----_---------_-------_-------------___-___________________ —___-------- -------------------- date Permit No.--v='- 0- ---------------------- ------------ Issued- - - - - - _ - -- ----------------------------__-------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS I TO CERT Y, That th Individual Well Constructed ( ` ), Altered ( ), or Repaired bY- Installer � `f at ' ( ---- - - ° -- r• �— - �` -- --- -- - - - - --------------------- has been installed in acc dance with the provisions of the Town of Barnstable Board of Health Private Well /Protection Regulation as described in the application for Well Construction Permit No. =� --Dated- /------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- —-- --- ----------- - Inspector-- ----— -- --- _-_-- ----- NO. O- -' Fee-- = �----- BOARD OF HEALTH TOWN OF BARNSTABLE ZippYication-*rMell �on�truct on ermit Applis t'on is hereby m e for a perm`?to Construct ( ), Alter ( ), or Repair ( an individual Well at: /) ! Location — Addfes yj Assessors Map and Parcel ---/�(/— -- - -----Owne --------% a— -------_--_---- Address— --- — — — ----- ——— --- —---------------—-------___ -- -- Installer — Driller Address Type of Building Dwelling---- Other - Type of Building No. of Persons --------- -- lr Type of Well--�,��i------ 4____—__ Capacity----________—____ _-- Purpose of Well— ----------- ------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. cy Signed date Application Approved Bye----------------------- -- - -- -- ---- (/---_�-- date Application Disapproved for the following reasons:---- ------------- -- _— date Permit No.-_ �U-- -—__--------- Issued-------- ---_ ------- — date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERT Y, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( V by----- --— ___G ! ------- -- - ------------------------------------------------------------------------------------------ Installer �� r �j� 112 at �------------- has /r -— - — __—_---------been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.UA) /L -Dated -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—----- ------- - — -- Inspector—--------— -- — --- BOARD OF HEALTH TOWN OF BARNSTABLE _ 1 Ivell con5truct ion permit No.-- ------- Fee--- ------ U �d•'ivil Permissionis hereby granted�'--------------/--------------------------------------------------------------------------------------------------------- to Construct Alter ( '10' or Repair (v) an Individual Well at: fLoll Street — ---— as shown on the application for a Well Construction Permit / ff- ----------------------------------------------- Dated_45r___.) /�--- - ----- ------- - -----------------Board of Heal �---------__—_ DATE-- �. C ----- ---------